§ 22:1060.3 — Continuation of coverage required; other drugs not precluded

Louisiana § 22:1060.3

• Jurisdiction: Louisiana
• Title 22: Insurance

Text

§1060.3. Continuation of coverage required; other drugs not precluded
A. A health insurance issuer of a health benefit plan that covers prescription drugs
shall offer to each enrollee at the contracted benefit level and until the enrollee's plan renewal
date any prescription drug that was approved or covered under the plan for a medical
condition or medical illness, regardless of whether the drug has been removed from the
health benefit plan's drug formulary before the plan renewal date. Nothing herein shall
prohibit the health insurance issuer from providing information to the enrollee regarding
alternative covered drugs.
B. This Section shall not prohibit a physician or other authorized prescriber from
prescribing a drug that is an alternative to a drug for which continuation of coverage is
required by Subsection A of this Section if the alternative drug meets each of the following
conditions:
(1) The drug is covered under the health benefit plan.
(2) The drug is medically appropriate for the enrollee.
C.(1) A health insurance issuer proposing to change its coverage of a particular
prescription drug or intravenous infusion based on medical necessity shall give notice of the
proposed change to an insured currently using that prescription drug or intravenous infusion
who the health insurance issuer determines the change may affect if the health insurance
issuer has covered the drug or intravenous infusion for the insured for at least the preceding
sixty days. Such notice shall be sent at least sixty days prior to the effective date of the
proposed change.
(2) Any insured receiving such a notice from a health insurance issuer shall have the
right to appeal the proposed change during the sixty-day notification period provided for in
Paragraph (1) of this Subsection in accordance with the Internal Claims and Appeals Process
and External Review Act, R.S. 22:2391 et seq. In filing such an appeal, the insured shall
document that his physician or authorized prescriber considers continued use of the drug or
intravenous infusion to be medically necessary.

Legislative History

Acts 2011, No. 350, §1, eff. Jan. 1, 2012; Acts 2012, No. 316, §1, eff. May 25, 2012; Acts 2016, No. 573, §1, eff. Jan. 1, 2017.